In Botswana, a nation once celebrated for its wealth, the ongoing economic decline is taking a severe toll on public health. Patients like Boitumelo Mosege are facing dire challenges in accessing essential medications, forcing them to rely on family support and risking their well-being. With the country’s diamond trade—its economic backbone—suffering, the fallout is evident in both healthcare and the daily lives of its citizens.
A Personal Battle with Illness
Boitumelo Mosege, a 53-year-old former farmer from Molepolole, is one of many grappling with the implications of insufficient healthcare. Diagnosed with hyperthyroidism in late 2023, she has experienced swelling in her neck, severe itching, and frequent fainting spells. Despite Botswana’s promise of free public healthcare, Mosege has received only sporadic access to her prescribed treatment. Compelled to purchase her own medications, she struggles to afford the 2,000 pula (£113) monthly cost, relying on her children’s occasional earnings and her mother’s pension of 1,400 pula (£77).
“I felt like I had lost my life right there,” she reflected, recalling the moment she realised she had to self-fund her healthcare. “I felt suicidal.”
The Burden of Caregiving
Nearby, Kelly Jansen, aged 39, has taken on the full-time responsibility of caring for her 83-year-old father, Gerhardus, who is wheelchair-bound. The family spends a significant portion of his pension on medications and vital supplies, including a blood pressure monitor and compression stockings. Jansen’s wish for more independence is evident as she seeks to secure an electric wheelchair for her father. “I want my life back,” she expressed, highlighting the emotional toll of caregiving amidst economic hardship.
A National Health Emergency
The deteriorating state of Botswana’s healthcare system gained national attention in 2025 when President Duma Boko declared a public health emergency. This came after a significant shortage of medicines and medical supplies, exacerbated by a long-standing dysfunction in health procurement practices. The president attributed these issues to a multi-year economic slump following a collapse in diamond prices, which account for 80% of the nation’s exports.
Boko’s opinion piece published in early 2026 underscored the urgent need for reforms. He pointed fingers at the Central Medical Stores (CMS), the government’s health procurement agency, for inflating drug prices. University of Botswana health policy lecturer Thabo Lucas Seleke echoed these sentiments, stating that the CMS has been in need of comprehensive reform since at least 2010. “It is a breeding ground for corruption,” he asserted, indicating that the situation is worsening rather than improving.
Economic Factors at Play
Historically, Botswana transformed from one of the world’s poorest nations at independence to one of Africa’s wealthiest, largely due to its diamond industry. The country enjoyed substantial economic growth and invested in public services, including a robust education system and comprehensive HIV/AIDS programmes. Yet, despite a GDP per capita of $7,695 (£5,697) in 2024, the nation faces stark healthcare challenges; maternal mortality rates are alarmingly high compared to other nations with similar wealth.
The recent downturn in diamond prices—plummeting by 60% over four years—has compounded existing economic vulnerabilities. Coupled with rising fuel prices stemming from international conflicts, the country’s economy contracted by an estimated 3% in 2024. Unemployment rates have climbed to 21%, with youth unemployment reaching a staggering 29% among those aged 15 to 35.
Struggles of the Middle Class
The economic strain is felt across all demographics, including the middle class. Phenyo Tanka, a 39-year-old mother of four, exemplifies the challenges faced by families as they tighten their belts. After her husband was laid off from his job as a mining engineer, Tanka’s family cut back on dining out and dismissed their domestic worker. Despite holding a degree in agriculture, she has struggled to secure employment since graduating in 2011.
Undeterred, Tanka has turned to entrepreneurship, selling homemade cakes and aspiring to launch a toilet paper factory. “I have two girls and I want them to know that they can also be independent, as ladies,” she stated, embodying the resilience many are showing in the face of adversity.
Why it Matters
The intersection of economic decline and healthcare accessibility in Botswana highlights a critical issue that affects the lives of ordinary citizens. As the nation grapples with the consequences of its dependency on diamond exports, the struggle for basic healthcare has become emblematic of broader systemic failures. The stories of individuals like Mosege, Jansen, and Tanka reveal the urgent need for strategic reforms and a diversified economy, ensuring that the promise of a healthy and prosperous future is not just a distant hope, but a tangible reality for all.
